Bx breast add lesion us imag

CPT 19084 is used for performing a biopsy on each additional breast lesion beyond the first one during the same session, using ultrasound guidance to precisely target suspicious tissue.

Showing rates for

National Average

Base Medicare rate

$351.61

This calculator gives a typical-case estimate using standard Medicare modifier rules. Actual payment depends on payer policies, documentation, code-specific CMS status indicators, and locality. Verify before billing.

RVU breakdown

Work RVU

1.55

PE RVU (NF)

9.16

MP RVU

0.16

Total RVU

10.87

Conversion factor: 32.3465 · Source: CMS MPFS RVU25A · Confidence: High

NCCI bundling edits

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Billing tips

Always verify the primary biopsy code (19083 for ultrasound-guided initial lesion) is billed first before appending 19084 for additional lesions
Impact: Prevents automatic denial as 19084 is an add-on code with zero payment when billed alone
Document each lesion's specific location (clock position, depth, quadrant, and distance from nipple) separately in the operative report
Impact: Supports medical necessity for multiple units and can prevent downcoding that would cost $351.61 per denied lesion
Bill 19084 in non-facility setting when performed in office or freestanding imaging center to capture the $277.86 technical component difference
Impact: Non-facility rate of $351.61 versus facility rate of $73.75 represents 377% higher reimbursement
Append modifier 59 or XS when biopsying lesions in different quadrants or breasts to overcome NCCI edits
Impact: Prevents bundling denials that would eliminate payment for additional lesions entirely
Submit pre-authorization for three or more additional lesions (total of four or more biopsies) as some payers flag this for medical necessity review
Impact: Reduces denial rate by approximately 60-70% for high-volume biopsy cases based on typical audit patterns
Ensure ultrasound images are permanently archived showing each distinct lesion and the biopsy needle within each target
Impact: Critical for audit defense; lack of imaging documentation is the primary cause of recoupment in post-payment audits

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Frequently asked questions

Can CPT 19084 be billed alone without another biopsy code?

No, CPT 19084 is an add-on code that must always be reported with the primary ultrasound-guided breast biopsy code 19083. Billing 19084 alone will result in automatic denial with zero payment.

How many times can I bill CPT 19084 on the same date of service?

You can bill 19084 for each additional lesion beyond the first, with no hard limit set by CPT. However, most payers scrutinize claims with more than 2-3 units and may require pre-authorization or peer review for medical necessity when four or more total lesions are biopsied.

What is the difference between CPT 19083 and 19084?

CPT 19083 is the primary code for the first ultrasound-guided breast lesion biopsy with a 2025 Medicare rate of approximately $400-450, while 19084 is the add-on code for each additional lesion at $351.61 non-facility or $73.75 facility rate.

Do I need modifier 59 when billing multiple units of 19084?

Modifier 59 or XS should be appended when NCCI edits bundle the procedure or when documentation needs to clearly show distinct anatomic sites. It is especially important when lesions might appear clustered or when billed with other breast procedures on the same date.

What is the 2025 Medicare reimbursement for CPT 19084?

The 2025 Medicare national average payment is $351.61 in non-facility settings (office/imaging center) and $73.75 in facility settings (hospital outpatient). Actual payment varies by MAC locality and may be adjusted by geographic practice cost indices.

Can CPT 19084 be billed for biopsies in both breasts?

Yes, when additional lesions are biopsied in both breasts during the same session, bill appropriate units of 19084 with RT and LT modifiers to designate laterality. Some payers may require modifier 50 for bilateral reporting instead.

What documentation is needed to support billing CPT 19084?

You must document each lesion's specific anatomic location, ultrasound guidance for each target, separate specimen collection and labeling, medical necessity for each biopsy, and archived ultrasound images showing the needle in each distinct lesion. Inadequate documentation is the leading cause of recoupment.